School of Medicine and Health Sciences Poster Presentations

Title

Use of Metformin, Pre-mixed Insulin and Glucagon-Like Peptide-1 Receptor Agonist as a Therapeutic Approach for Uncontrolled Type 2 Diabetes Mellitus

Document Type

Poster

Abstract Category

Health Sciences

Keywords

Type 2 Diabetes Mellitus, Insulin-Dependent, Obesity

Publication Date

Spring 5-1-2019

Abstract

Objective: To explore the use of premixed insulin, glucagon-like peptide-1 receptor agonist (GLP-1 RA) and metformin as a combination therapy for Type 2 Diabetes Mellitus (T2DM) over 12 months. Methods: All adult patients with T2DM who had been given premixed insulin and a form of GLP-1-RA simultaneously at our outpatient clinic were selected for retrospective review. We reviewed Hemoglobin A1c (HbA1c), weight, cumulative daily insulin dose, and adverse events over 12 months. Results: A total of 72 patients received premixed insulin and GLP-1 RA with 32 patients meeting inclusion criteria. Average duration of T2DM was 14.2 (Standard Deviation [SD] 7.1) years. Mean HbA1c at baseline was 10.5%±2.1 (91 mmol/mol). At 12 months mean HbA1c was 8.3%±1.9 (67 mmol/mol). Mean HbA1c change after 12 months was -2.2 (95% Confidence Interval [CI] -3.433 to -1.014; p < 0.0001). At 12 months, cumulative insulin dose was 33.3 units less than total insulin dose prior to therapy change (CI -57.13 to -9.46; P = 0.0030). Average weight loss at 12 months was -2.2kg (CI -27.6 to 37.6, p = 0.9293). After 12 months, 61% (19 out of 31) had HbA1c ≤ 8% (64 mmol/mol). Of note, adverse events were seen in six additional patients not included in analysis as they stopped regimen after <3 months. Conclusion: Despite decreasing cumulative daily dose of insulin, patients with historically uncontrolled T2DM using metformin, premixed insulin and GLP-1 RA had improved glycemic control over 12 months. Prospective randomized studies need to be done to assess the benefit of this combination of available medication therapy.

Open Access

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Presented at Research Days 2019.

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Use of Metformin, Pre-mixed Insulin and Glucagon-Like Peptide-1 Receptor Agonist as a Therapeutic Approach for Uncontrolled Type 2 Diabetes Mellitus

Objective: To explore the use of premixed insulin, glucagon-like peptide-1 receptor agonist (GLP-1 RA) and metformin as a combination therapy for Type 2 Diabetes Mellitus (T2DM) over 12 months. Methods: All adult patients with T2DM who had been given premixed insulin and a form of GLP-1-RA simultaneously at our outpatient clinic were selected for retrospective review. We reviewed Hemoglobin A1c (HbA1c), weight, cumulative daily insulin dose, and adverse events over 12 months. Results: A total of 72 patients received premixed insulin and GLP-1 RA with 32 patients meeting inclusion criteria. Average duration of T2DM was 14.2 (Standard Deviation [SD] 7.1) years. Mean HbA1c at baseline was 10.5%±2.1 (91 mmol/mol). At 12 months mean HbA1c was 8.3%±1.9 (67 mmol/mol). Mean HbA1c change after 12 months was -2.2 (95% Confidence Interval [CI] -3.433 to -1.014; p < 0.0001). At 12 months, cumulative insulin dose was 33.3 units less than total insulin dose prior to therapy change (CI -57.13 to -9.46; P = 0.0030). Average weight loss at 12 months was -2.2kg (CI -27.6 to 37.6, p = 0.9293). After 12 months, 61% (19 out of 31) had HbA1c ≤ 8% (64 mmol/mol). Of note, adverse events were seen in six additional patients not included in analysis as they stopped regimen after <3 months. Conclusion: Despite decreasing cumulative daily dose of insulin, patients with historically uncontrolled T2DM using metformin, premixed insulin and GLP-1 RA had improved glycemic control over 12 months. Prospective randomized studies need to be done to assess the benefit of this combination of available medication therapy.